Mr. President, I appreciate the leadership that Senators Smith and Bingaman are showing with regard to Medicaid. I rise today to speak in support of the pending bipartisan amendment offered by Senators Smith and Bingaman to eliminate the…
Mr. President, I appreciate the leadership that Senators Smith and Bingaman are showing with regard to Medicaid.
I rise today to speak in support of the pending bipartisan amendment offered by Senators Smith and Bingaman to eliminate the $15 billion in cuts to the Medicaid program mandated under this resolution. Instead of letting the budget process drive Medicaid reform, this amendment directs the creation of a bipartisan Medicaid commission to investigate and consider possible improvements to the Medicaid program. In other words, this amendment would ensure that policy drives Medicaid reform, not the arbitrary and unjustified cuts in this resolution.
Last week Senators Wyden, Murray, Johnson and I offered a successful amendment during markup of this resolution. The sense of the Senate we offered, which was agreed to unanimously by the Budget Committee and is a part of this resolution, states that the Finance Committee shall not achieve any savings under reconciliation that would cap Federal Medicaid spending, shift Medicaid costs to the States or providers, or undermine the Federal guarantee of Medicaid health insurance.
It simply is not possible to cut $15 billion from the Medicaid program without violating this agreement. Cutting $15 billion from Medicaid means taking $15 billion directly from the States. It means that States will be left with the tough choices of decreasing reimbursements to providers, eliminating services like prescription drugs and specialized services for the mentally retarded for families and elderly who rely on Medicaid now for these services, or raising taxes to preserve these services.
These cuts come at a time in which States are already struggling with the escalating costs of the Medicaid program. In 1985, 8 percent of State budgets went to Medicaid. Today, on average, 22 percent of States' budgets are spent on Medicaid. In New Jersey, fourteen percent of the State budget is spent on Medicaid. States are having to make tough choices about whether to cut critical health services for their most vulnerable or reducing funding for education programs.
What this resolution says to States and the 53 million children, pregnant women, elderly, and disabled who would be uninsured without Medicaid coverage is that they are simply going to have tough decisions. We are in tough budget times so you are going to have to choose between cutting health care or education.
I would like to share with my colleagues a couple of charts that demonstrate the tough choices that Chairman Gregg and the President are asking us to make. This first chart compares the $15 billion in Medicaid cuts that the Chairman has assumed to balance the budget along with the $204 billion cost of making the President's tax cuts for millionaires permanent. These are the tough choices--preserving access to health care for millions of poor Americans or handing out hundreds of millions in taxes to the wealthiest in our country--which this budget poses. Frankly, I don't think this is a tough choice. It is an easy one. We must preserve access to health care for our Nation's most vulnerable and we must maintain our Federal obligation to the States to pay our fair share for these services.
I would like to point out that States are also facing massive costs as they work to transition their Medicaid beneficiaries who are dually eligible for Medicare into the new Medicare prescription drug benefit. States like New Jersey that have State pharmacy assistance programs for non-Medicaid eligible seniors will also have to bear significant new costs to ensure that these programs coordinate with the new Medicare drug benefit.
Not only are States going to have to bear enormous costs of transitioning these beneficiaries, but if they choose to provide more generous benefits than offered under the Medicare law they will have to finance those benefits with State dollars. My State of New Jersey, which plans to wraparound the Medicare benefit to ensure that those on Medicaid have access to the prescription drugs they need, has estimated that the State will spend an additional $92 million in 2005 and 2006 to pay for these costs.
Now, under this resolution, New Jersey would lose $90 million a year in Federal Medicaid funding. How much more money is the Federal Government going to demand from the States? It is outrageous and unfair and it is an abdication of our Federal responsibility to force these costs on the States.
I asked my State to tell me what kind of impact that a $90 million loss in Federal funding would have on New Jersey's Medicaid program. The Medicaid director in my State gave me two options: the State will either have to eliminate health insurance for more than 20,000 low- income children and pregnant women who are considered ``optional'' beneficiaries because they earn just above 133 percent of the poverty level, which is $20,000 for a family of four. Or the State could eliminate so called ``optional'' services, including dental care, pediatric and optometric care, hearing aid services, optical appliances, psychological services, hospice care, and medical day care for individuals with Alzheimer's and dementia. And of course, there is a third option--increasing taxes to maintain these services.
We simply can't address the underlying problem of escalating health care costs, which are driving up the costs of the Medicaid program, by asking States to cough up more money or by forcing them to eliminate critical services. We need meaningful, long-term solutions that will control health care costs across the board for Medicaid, as well as for Medicare and private insurance.
We need to change the fact that nationally 42 percent of Medicaid expenditures are spent on Medicare beneficiaries. This is because Medicare does not provide long-term care. So when we talk about a Medicaid crisis, what we really should talk about is the crisis in long-term care in this country. We are an aging population. As my generation retires, we will demand more long-term care services. Yet we have no long-term care system in this country. As it currently stands, the Medicaid program is our long-term care program.
The Smith-Bingaman amendment directs the creation of a bipartisan Medicaid commission to investigate these issues and to develop recommendations on how to decrease costs in the Medicaid program without burdening States or cutting services. A commission comprised of members of congress, governors, State Medicaid directors, and beneficiary advocates is necessary to develop real policies to strengthen Medicaid. It simply does not make sense to pull a number out of thin air like this resolution does. Policy should drive the numbers--not the other way around.
I urge all of my colleagues to adopt the sensible approach proposed by Senators Smith and Bingaman.
I don't understand how we can have a process of Medicaid reform driven by budgets without thinking through where that is going to come from. We heard our other colleague talk about where the burden of those cuts will fall.
I specifically asked what would happen if the proportionate deduction of cuts in New Jersey were to occur, which would be by the Senate's version about $90 million to the State, and the gross-up would be $180 million.
We are talking about Alzheimer's daycare for seniors. We are talking about hospice care. We are talking about basic dental, chiropractic care, hearing aids, and optical for our seniors.
It is impossible to understand how we want to take this hard cut without knowing the direction we are going to take.
Mr. President, I ask my colleagues to support the intelligent and responsible approach that Senators Smith and Bingaman proposed.
Mr. President, the process of developing a budget each year provides an opportunity to take stock of our priorities as a nation.
The President outlines his priorities through his budget, but it is the Congress, with its control of the purse strings, that is ultimately charged with the responsibility of fashioning and enacting legislation.
Regrettably, the priorities reflected in this budget resolution-- which mirror those in the administration's budget proposal--are wrong for America and certainly wrong for the people of New Jersey.
In New Jersey, we are particularly sensitive to the choices made by this administration and its allies in Congress, since we provide the greatest contribution of taxes paid relative to what we get back from the Federal Government. Our return on the Federal dollar has fallen from 70 cents to a meager 57 cents under the Bush administration. This budget will only further increase the strain on New Jersey's citizens, especially our most vulnerable: our children, our disabled, and our seniors.
According to the resolution before us, this administration and this congressional leadership's priorities include underfunding No Child Left Behind by an astounding $12 billion next year, which means that 53,152 students in New Jersey will not be served by the title I program and 32,822 fewer kids in New Jersey will have a safe place to go after school. I am disappointed that this body on Monday rejected an opportunity to restore some of this funding.
According to this resolution, Republican leadership's priorities include cutting $15 billion from the Medicaid Program over the next 5 years. If these cuts take effect, New Jersey would lose $90 million a year in Federal Medicaid funding.
I asked my State to tell me what they would do if they lost this funding. They told me there are two options: The State will either have to eliminate health insurance for more than 20,000 low-income children and pregnant women who are considered ``optional'' beneficiaries because they earn just above 133 percent of the poverty level, which is $20,000 for a family of four; or, the State could eliminate ``optional'' services, including dental care, hearing aid services, psychological services, and medical daycare for individuals with Alzheimer's and dementia.
The Republican leadership's priorities include cutting Amtrak's entire operating subsidy. I doubt the 82,000 commuters who ride New Jersey Transit trains every day would agree with this policy choice, since their trains operate along Amtrak's Northeast corridor rail. Neither, I know, would the literally millions who rely on Amtrak to travel interstate.
Let's not forget cuts for our veterans and first responders and weakened investment in community development. The list goes on and on.
All in all, under President Bush's budget, my home State of New Jersey stands to lose nearly $300 million next year, adjusted for inflation, according to the Center on Budget and Policy Priorities and that is before you even estimate his implied cuts to Medicaid. If Congress fails to act, cuts under our budget could be of a similar magnitude.
These cuts do not come as part of some shared sacrifice driven by tough fiscal times, as some would have us believe. Most of these program cuts are only a drop in the bucket compared to the cost of President Bush's tax cuts for the most fortunate.
In all, the Bush administration has reduced Federal revenues to their lowest level as a share of the economy since the 1950s. As a consequence, we no longer have the resources to deal with the Nation's priorities--that is why they want to cut funding for veterans and education and health care and community development.
Next year, people with incomes greater than $1 million will receive $32 billion from President Bush's tax breaks. Compare this $32 billion cost to the $220 million that the President has proposed cutting from the Low Income Heating Assistance Program, which helps low-income families and seniors pay their heating and cooling bills. We would literally be throwing people out in the cold--405,000 of them, to be precise, or more than 7,000 in New Jersey--to pay for less than 1 percent of President Bush's tax breaks for millionaires.
This choice simply does not reflect our Nation's fundamental values. I don't think it reflects the values of even those benefiting most from it. Nor does it address the real needs of working families in New Jersey and across America.
That reality includes rising health care costs that are driving families into bankruptcy like never before and preventing businesses from creating jobs. It includes growing wage disparity and a labor market that's stayed weaker for longer coming out of a recession than any other time on record.
According to the Tax Policy Center of the Urban Institute and the Brookings Institution, more than 70 percent of the benefits of the President's tax breaks enacted in 2001 and 2003 go to the 20 percent of taxpayers with the highest incomes. More than 25 percent of the taxcut benefits go to the top 1 percent.
I believe that America stays strong by investing in its people and its communities, not by abandoning them.
Let's remember the context. Since President Bush took office, the Federal budget deficit has deteriorated every year. This year, we are expected to be $427 billion in the hole.
In light of this record, President Bush and his Congressional allies' recent claims of fiscal responsibility simply are not credible. This budget makes those claims even less credible by achieving much of its purported ``cost savings'' by passing the buck to State and local governments.
Lowering the numbers here in Washington is not the same thing as fiscal discipline if this is simply an exercise in shifting cost burdens to states and communities. That is hardly a plus for the American people and certainly not for New Jersey.
Our States are already stretched too thin. In New Jersey, we have a budget shortfall of $4-$5 billion and annual property tax increases of 7 percent. Much of the reality for States in budget and tax policy has been the result of cost burdens and unfunded mandates passed down from this administration and its allies in Congress.
We have heard claims from the other side that their tax cuts for the most fortunate are somehow responsible for providing a boost to our economy. But as any serious minded economist not on the Republican payroll will tell you, the real story of our modest growth has
been the longest sustained monetary expansion on record by the Federal Reserve.
Claims that the tax cuts are responsible for significant economic growth are reminiscent of a rooster taking credit for the Sun coming up.
The more noticeable result of the tax cuts has been an explosion in our Nation's debt, starting with the $1.8 trillion cost over 10 years of making the cuts permanent. If we continue along the path set by this administration, by 2015, each family's share of the national debt will be $73,563. This is simply unacceptable.
As we develop this year's budget, I hope we take a long, hard look at the priorities our Nation has followed under this president. Because, in my view, those priorities need major changes.
As I said earlier, it is the job of the President to reflect his priorities, but it is the role of Congress to reflect the priorities of America, of our families, and of our workers.
I hope we will not fail them.